The announcement by the Centers for Disease Control and Prevention earlier this month of the detection of the first three confirmed cases of Middle East Respiratory Syndrome (MERS) in the United States is noteworthy. This is aside from the fact the disease currently carries a 30% case fatality rate, with the origins of the MERS coronavirus (MERS-CoV) elusive along with exact mechanisms of transmission.

First, it represents an approximately two-year period since the initial recognition of the disease in Saudi Arabia that has expanded to 17 countries with confirmed cases. While its formal arrival to the U.S. has been long anticipated, it is likely that the virus made a much earlier debut here given the frequency and prevalence of air travel. Therefore, the plausibility that the virus is already circulating in the U.S. population cannot be discounted.

Second, mild or asymptomatic infections with the virus would not be recognized in any country if infected individuals did not seek or require acute health care. The latest reported case in an Illinois man being touted as the first possible human-to-human MERS transmission in the U.S. is a case in point. The man had no discernible clinical symptom of MERS infection and was only identified by epidemiologic link to the first reported case.

Third, two of the reported cases are in health care providers. This is troublesome since it is somewhat reflective of the 2003 SARS outbreak. During that event, health care providers served both as transmission vectors and victims in a worldwide outbreak that resulted in close to 800 deaths before mysteriously disappearing. This is problematic when one considers that medical providers are the first line of defense in controlling and containing infectious disease outbreaks in most communities.

Finally, the U.S. MERS cases demonstrate significant and continued gaps in U.S. biosurveillance. For example, while public health guidance exists for planning and response to communicable disease events on international flights, there is not corresponding protocols for domestic flights. Responding to novel disease scenarios requires public health officials to have a large toolkit that enables rapidly identifying everyone who may represent a known contact to a confirmed case. Lack of protocols on obtaining flight seating plans and passenger manifests currently makes this type of critical assessment extremely challenging.

All of this raises questions regarding the visibility and practice of the National Health Security Strategy (NHSS). This is the war plan developed by the Department of Health and Human Services that serves as guidance in combating infectious diseases that pose a threat to our country's critical infrastructure. The thinking is that any severe and unmitigated disease that threatens certain core national capabilities such as military, economic and health sectors by default is a threat to our homeland security. The NHSS provides the framework for public health officials to consider enhancing surveillance, deploying medical countermeasures and coordinating response activities with federal agencies.

Yet few Americans have heard of the strategy, much less understand its potential application or utility. In the aftermath of the H1N1 pandemic and given the potential global spread of MERS, it's time to bring the strategy to the forefront for both public consumption and debate.

On domestic and international terrorism, there has been ample coverage and discussion of law enforcement and intelligence-gathering efforts and prevention and response. Similar focus needs to be directed in the development and vetting of public health intelligence response strategies to protect the U.S. population against the proliferation of microbial terrorism.

However, providing visibility to the NHSS is only a first step. A more comprehensive plan is needed. It conceivably could include utilization of better field bioassay and surveillance technology across national boundaries and within key transport hubs, improved international cooperation and fluid information-sharing and consensual strategic decision-making on a response inclusive of resource needs and allocation.

In addition, better public awareness, engagement and acclimation to bioevent preparedness and consequences are long overdue and must not remain relegated to the back burner for fear of public panic, misunderstanding or overreaction. Authentic and equitable partnerships can result in equitable sharing of roles and responsibility across the spectrum of response and strengthen overall community resiliency as a result.

MERS-CoV along with a host of novel influenza viruses circulating in China and the Southeast Asian corridor are very real reminders of potential pandemic disease threats that are no longer the realm of science fiction. The most recent reports of MERS infection in three individuals with a novel virus that likely emerged thousands of miles away from the U.S. doorstep underscore the reality and relevance of shoring up our national health security in the 21st century.